The impact of COVID‐19 epidemic on eating disorders: A longitudinal observation of pre versus post psychopathological features in a sample of patients with eating disorders and a group of healthy controls

Castellini, Giovanni; Cassioli, Emanuele; Rossi, Eleonora; Innocenti, Matteo; Gironi, Veronica; Sanfilippo, Giulia; Felciai, Federica; Monteleone, Alessio M.; Ricca, Valdo

doi:10.1002/eat.23368

Cited by 223Eating Disorders and BehaviorsCOVID-19 and Mental HealthNutrition, Health and Food Behavior

The impact of COVID‐19 epidemic on eating disorders: A longitudinal observation of pre versus post psychopathological features in a sample of patients with eating disorders and a group of healthy controls

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Castellini, Giovanni, Cassioli, Emanuele, Rossi, Eleonora, Innocenti, Matteo, Gironi, Veronica, Sanfilippo, Giulia, Felciai, Federica, Monteleone, Alessio M. +1 more·2020·International Journal of Eating Disorders

DOI 10.1002/eat.23368PMC PMC7461528

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Abstract

OBJECTIVE: the aim of this longitudinal study was to evaluate the impact of COVID-19 epidemic on Eating Disorders (EDs) patients, considering the role of pre-existing vulnerabilities. METHOD: 74 patients with Anorexia Nervosa (AN) or Bulimia Nervosa (BN) and 97 healthy controls (HCs) were evaluated before lockdown (T1) and during lockdown (T2). Patients were also evaluated at the beginning of treatment (T0). Questionnaires were collected to assess psychopathology, childhood trauma, attachment style, and COVID-19-related post-traumatic symptoms. RESULTS: A different trend between patients and HCs was observed only for pathological eating behaviors. Patients experienced increased compensatory exercise during lockdown; BN patients also exacerbated binge eating. Lockdown interfered with treatment outcomes: the descending trend of ED-specific psychopathology was interrupted during the epidemic in BN patients. Previously remitted patients showed re-exacerbation of binge eating after lockdown. Household arguments and fear for the safety of loved ones predicted increased symptoms during the lockdown. BN patients reported more severe COVID-19-related post-traumatic symptomatology than AN and HCs, and these symptoms were predicted by childhood trauma and insecure attachment. DISCUSSION: COVID-19 epidemic significantly impacted on EDs, both in terms of post-traumatic symptomatology and interference with the recovery process. Individuals with early trauma or insecure attachment were particularly vulnerable.

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The current trends in the number and proportion of mental health condition-related emergency department visits, along with previous research, indicate that the mental health effects of the pandemic might be particularly high among adolescent girls.
“The current trends in the number and proportion of MHC-related ED visits, along with previous research ( 1 , 2 , 4 -8 ), indicate that the mental health effects of the pandemic might be particularly high among adolescent girls.”
From Pediatric Emergency Department Visits Associated with Mental Health Conditions Before and During the COVID-19 Pandemic — United States, January 2019–January 2022 (2022) · cites this paper as [4]
Eating disorders can be triggered by pandemic-related risk factors (such as lack of structure in daily routine, emotional distress, and changes in food availability) or exacerbated by reduced access to mental health care during the pandemic.
“Eating disorders can be triggered by pandemic-related risk factors (e.g., lack of structure in daily routine, emotional distress, and changes in food availability) or exacerbated by reduced access to mental health care during the pandemic ( 4 , 5 ).”
From Pediatric Emergency Department Visits Associated with Mental Health Conditions Before and During the COVID-19 Pandemic — United States, January 2019–January 2022 (2022) · cites this paper as [4]
In Castellini et al. (2020), comparing baseline to T1, patients with EDs reported an improvement of general psychopathology and ED-specific symptoms, objective binge eating, and compensatory physical exercise.
“While comparing baseline to T1, patients with EDs reported an improvement of general psychopathology and ED-specific symptoms, objective binge eating and compensatory physical exercise.”
From Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review (2021) · cites this paper as Castellini et al. (2020)
In Castellini et al. (2020), despite 10 full remissions and 19 partial remissions at T1, 10 subjects reported a relapse into BN at T2.
“Despite 10 full remissions and 19 partial remissions at T1, 10 subjects reported a relapse into BN at T2.”
From Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review (2021) · cites this paper as Castellini et al. (2020)
In Castellini et al. (2020), the ED group reported higher COVID-19-related post-traumatic stress symptoms compared with the healthy control group.
“Moreover, the ED group reported higher COVID-19-related post-traumatic stress (PTS) symptoms in comparison with the HC group.”
From Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review (2021) · cites this paper as Castellini et al. (2020)

In Castellini et al. (2020), BMI increased significantly in patients with AN while remaining stable in patients with BN.
“Moreover, BMI increased significantly in patients with AN while remaining stable in patients with BN.”
From Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review (2021) · cites this paper as Castellini et al. (2020)
In Castellini et al. (2020), comparisons between pre- and post-lockdown (T1-T2) revealed that patients with EDs increased physical exercise during lockdown despite the initial improvement.
“Comparisons between pre- and post-lockdown (T1–T2) revealed that patients with EDs increased physical exercise during lockdown despite the initial improvement.”
From Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review (2021) · cites this paper as Castellini et al. (2020)
In Castellini et al. (2020), no significant change was found in the healthy control group.
“No significant change was found in the HC group.”
From Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review (2021) · cites this paper as Castellini et al. (2020)
In Castellini et al. (2020), patients with AN reported an improvement in BMI and specific ED psychopathology, whereas patients with BN exhibited an increase of objective binge eating.
“Some specific differences between diagnostic subgroups emerged: patients with AN reported an improvement in BMI and specific ED psychopathology, whereas patients with BN exhibited an increase of objective binge eating.”
From Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review (2021) · cites this paper as Castellini et al. (2020)
In Castellini et al. (2020), childhood trauma and insecure attachment style were factors for COVID-19-related post-traumatic stress symptoms in patients with AN.
“Childhood trauma and insecure attachment style resulted in the factors for COVID-19-related PTS symptoms in patients with AN.”
From Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review (2021) · cites this paper as Castellini et al. (2020)
In Castellini et al. (2020), the main factor of increase in pathological physical exercise was household arguments, while fear of safety for loved ones predicted a higher increase in binge eating episodes.
“Interestingly, the main factor of increase in pathological physical exercise was household arguments, while the fear of safety for the loved ones predicted a higher increase in binge eating episodes.”
From Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review (2021) · cites this paper as Castellini et al. (2020)
Patients with eating disorders experienced worsening preoccupation with weight and body shape during the pandemic due to difficulties in continuing compensatory behaviors, including compulsive physical exercise.
“Patients with EDs experienced during pandemic the worsening of their preoccupation with weight and body shape, due to the difficulties in continuing their compensatory behaviors, including compulsive physical exercise (Castellini et al., 2020; Clark Bryan et al., 2020; Phillipou et al., 2020; Richardson et al., 2020; Schlegl et al., 2020a,b).”
From Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review (2021) · cites this paper as Castellini et al., 2020
Patients with eating disorders experienced worsening of symptoms as a direct consequence of deprivation in relationships with significant others, especially when an insecure attachment style was present.
“Patients with EDs experienced the worsening of their symptoms as a direct consequence of deprivation in relationships with the significant ones, especially when an insecure attachment style was present (Castellini et al., 2020).”
From Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review (2021) · cites this paper as Castellini et al., 2020
Only two longitudinal cohort studies compared pre- vs. post-pandemic behaviors or tried to find predictors of negative outcomes during pandemic.
“There are only two longitudinal cohort studies (Castellini et al., 2020; Puhl et al., 2020) that compared pre- vs. post-pandemic behaviors or tried to find predictors of negative outcomes during pandemic.”
From Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review (2021) · cites this paper as Castellini et al., 2020

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The Impact of the COVID-19 Pandemic on Those Supported in the Community with Long-Term Mental Health Problems: A Qualitative Analysis of Power, Threat, Meaning and Survival
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The Psychological Impact of the COVID-19 Pandemic on Alcohol Abuse and Drunkorexia Behaviors in Young Adults
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Evaluating the impact of COVID ‐19 on severity at admission and response to inpatient treatment for adult and adolescent patients with eating disorders
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Nutritional Behavior in European Countries during COVID-19 Pandemic—A Review
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The Impact of the First and Second Wave of the COVID-19 Pandemic on Eating Symptoms and Dysfunctional Eating Behaviours in the General Population: A Systematic Review and Meta-Analysis
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The Impact of COVID-19 on Adolescents with Eating Disorders: A Cohort StudyPreprint
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The impact of COVID-19 on eating disorders: A longitudinal study with assessments before and after the lockdown
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COVID-19 pandemic and eating disorders: What impact on specific and general psychopathology?
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The impact of COVID-19 lockdown and of the following “re-opening” period on specific and general psychopathology in people with Eating Disorders: the emergent role of internalizing symptoms
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The psychological impact of COVID-19 and lockdown measures among a sample of italian patients with eating disorders: A longitudinal study
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How Is the History of Early Traumatic Exposure Associated With the Psychopathological Outcomes of COVID-19 Related Lockdown and Subsequent Re-opening in People With Eating Disorders?
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Authors: Castellini, G., Cassioli, E., Rossi, E., Innocenti, M., Gironi, V., Sanfilippo, G., Felciai, F., Monteleone, A. M., & Ricca, V.
Affiliations: University of Florence (IT)
University of Campania "Luigi Vanvitelli" (IT)
Corresponding author: Castellini, Giovanni
ORCID: Castellini, Giovanni
Cassioli, Emanuele
Rossi, Eleonora
Innocenti, Matteo
Monteleone, Alessio M.
Ricca, Valdo
Venue: International Journal of Eating Disorders
Publisher: Wiley
Published: 2020-08-28
Volume: 53
Issue: 11
Pages: 1855-1862
ISSN: 0276-3478 (ISSN-L)
1098-108X
DOI: 10.1002/eat.23368
PMC: PMC7461528
OpenAlex: W3080599908
Cited by: 223
References: 30
Citations by year: 2026: 7 · 2025: 10 · 2024: 25 · 2023: 45 · 2022: 66 · 2021: 66 · 2020: 3
FWCI: 17.91
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: International Journal of Eating Disorders (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Florence Research (University of Florence) (submittedVersion)
Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli" (submittedVersion)
Topics: Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
Keywords: COVID-19 pandemic, eating disorders, anorexia nervosa, bulimia nervosa, lockdown, compensatory exercises, binge eating, posttraumatic stress symptoms, childhood trauma, insecure attachment, treatment outcomes, family conflict
MeSH terms: Psychological Trauma, COVID-19, Adolescent, Adult, Feeding and Eating Disorders, Feeding Behavior, Female, Humans, Italy, Longitudinal Studies, Middle Aged, Object Attachment, Pneumonia, Viral, Quarantine, Surveys and Questionnaires, Stress Disorders, Post-Traumatic, Exercise, Case-Control Studies, Coronavirus Infections, Young Adult, Pandemics

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The impact of COVID‐19 epidemic on eating disorders: A longitudinal observation of pre versus post psychopathological features in a sample of patients with eating disorders and a group of healthy controls

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